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Angina 1 year after percutaneous coronary intervention: a report from the NHLBI Dynamic Registry
Richard Holubkov1, Warren K Laskey, Amelia Haviland
1Department of Epidemiology, Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pa 15261, USA. holubkov@edc.gsph.pitt.edu
Insights
Recurrent angina after percutaneous coronary intervention (PCI) affects 26% of patients at 1 year, particularly females and those with prior myocardial infarction (MI). Angina is linked to reduced quality of life, highlighting its importance as a follow-up outcome.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Percutaneous coronary intervention (PCI) is primarily performed to alleviate angina.
- Identifying factors predicting angina recurrence post-PCI is crucial for patient management.
- Understanding long-term symptom burden after PCI informs treatment strategies.
Purpose of the Study:
- To identify patient and procedural factors associated with angina recurrence 1 year after PCI.
- To assess the impact of residual coronary artery disease (CAD) and reinterventions on angina symptoms.
- To evaluate the significance of angina as a follow-up outcome in PCI patients.
Main Methods:
- Analysis of 1-year follow-up data from 1755 patients undergoing PCI in the NHLBI Dynamic Registry.
- Assessment of patient demographics, medical history, procedural details, and symptom reporting at 1 year.
- Statistical analysis to determine predictors of 1-year angina, including subgroup comparisons.
Main Results:
- 26% of patients reported angina at 1-year follow-up.
- Younger age, female sex, prior myocardial infarction (MI), diabetes, and extensive coronary artery disease (CAD) were associated with increased angina.
- Patients with residual multivessel CAD and those undergoing repeat PCI reported more symptoms; stent use and complete revascularization were associated with less angina.
Conclusions:
- While most patients are angina-free post-PCI, a significant minority experience recurrence.
- Female sex, younger age, and history of MI are key predictors of persistent angina.
- Angina significantly impacts quality of life, necessitating its inclusion as a primary outcome measure in PCI evaluations.
Background:
As percutaneous coronary intervention (PCI) is most commonly performed for relief of angina, it is important to identify factors associated with recurrence of anginal symptoms.
Methods:
We examined symptoms at 1-year follow-up in 1755 consecutive NHLBI Dynamic Registry patients who underwent PCI in the setting of symptoms or acute infarction.
Results:
At 1-year follow-up, 26% of patients reported angina in the previous 6 weeks. Younger patients and females reported more symptoms. History of coronary artery bypass graft (CABG) or PCI, prior myocardial infarction (MI), diabetes, graft disease, and extensive coronary artery disease (CAD) (>4 significant lesions) were also associated with follow-up angina. Patients receiving stents reported less angina (24% vs 29%, P <.05). Completely revascularized patients and those with residual single-vessel disease had comparable 1-year angina rates (23% both subgroups), while 32% of patients with residual multivessel CAD reported symptoms. Patients undergoing repeat PCI during follow-up reported more 1-year angina than others (34% vs 24%, P <.001), whereas those undergoing CABG after post-PCI hospitalization had less symptoms (15% vs 26%, P <.05). After adjustment for baseline symptom status and outcome of index PCI, residual CAD, and reintervention during follow-up, patient characteristics significantly predictive of angina included female sex, age <62 years, and prior MI.
Conclusions:
While approximately three quarters of patients receiving PCI are angina-free at 1 year, females continue to have more symptoms, as do other subgroups including patients with history of MI or previous intervention. As these symptoms are associated with self-reported activity and quality of life limitation, evaluations of PCI should include angina as a key follow-up outcome.